Myoma Uteri

myomauteri-1-0-25kapak

Myomas and Pregnancy

Filiz F. Bilgin Yanık

Private Practice of Gynecology and Obstetrics, Ankara, Türkiye

Bilgin Yanık FF. Myomas and Pregnancy. Yavuz AF, ed. Myoma Uteri. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.153-164.

ABSTRACT

Uterine leiomyomas, also called shortly myomas or fibroids, are the most common benign neoplasms of the reproductive tract and originate from the smooth muscle cells. The prevalence is 20-25% in women of reproductive age and it is about 2% during pregnancy, although this may vary according to the characteristics of the pregnant population. Uterine myomas are more easily recognized and assessed in the non-pregnant state compared to the pregnant state. Ultrasonography is the major diagnostic tool. Myomas in pregnant women may grow in size especially in the first and early second trimesters. The number, size and location of them, as well as the relationship to the placenta affect the morbidity throughout the pregnancy. Retroplacental myomas, multiple myomas >3 in number and the ones greater than 5 cm in diameter are associated with a higher incidence of miscarriage, intrauterine growth restriction, preterm labor and delivery, placental abruption, placenta previa, fetal malpresentations, dystocia in labor, Cesarean delivery and postpartum hemorrhage. Previous myomectomy via laparoscopy, laparotomy or hysteroscopy poses a major risk of uterine rupture to women during pregnancy or in labor, especially when the incision has involved the myometrium and the endometrium and the time elapsed after the surgery has been less than one year. Endometrial scarring might increase the risk of placenta acreta spectrum as well. Pain is the most common symptom related to myomas during pregnancy. It may occur due to growth, degeneration or torsion of the myomas. These complications may cause prostaglandin release and induce premature uterine contractions. Antepartum myomectomy is rarely necessary in case of intractable bleeding or torsion. In pregnant women with myomas vaginal delivery is preferred unless there is fetal malpresentation, malposition, labor dystocia, placental abruption, placenta previa or any other obstetric indications for Cesarean deivery. Concomitant myomectomy during Cesarean section is generally not preferred because it may prolong the operation time, increase intraoperative blood loss and increase the need for blood transfusion. However it may be performed in selected cases such as isolated pedunculated subserosal myomas, in order to avoid a second surgery in the future.

Keywords: Leiomyoma; Pregnancy; Pregnancy complications; Uterine myomectomy; Cesarean section

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